USING WHO INDICATORS USING WHO INDICATORS TO MONITORTO MONITORTHE IMPLEMENTATION OF THE IMPLEMENTATION OF NATIONAL DRUG POLICYNATIONAL DRUG POLICYRelationship between country characteristic and Relationship between country characteristic and background, structure, process and outcome background, structure, process and outcome indicatorsindicators

Dripa SjabanaDripa Sjabana11 & Sri Suryawati & Sri Suryawati22

11Graduate Programme for Medicine Policy Graduate Programme for Medicine Policy and Managementand Management

22Centre for Clinical Pharmacology and Centre for Clinical Pharmacology and Medicine Policy Studies Medicine Policy Studies

Gadjah Mada University, Yogyakarta, Gadjah Mada University, Yogyakarta, IndonesiaIndonesia

Problem Statement:Problem Statement: Many countries have used WHO Many countries have used WHO indicators to evaluate the implementation of NDP, and data indicators to evaluate the implementation of NDP, and data are available in WHO documents. It would be interesting to are available in WHO documents. It would be interesting to evaluate the currently available country data, and to see if evaluate the currently available country data, and to see if there is a particular pattern of relationship among there is a particular pattern of relationship among indicators’ values with the country characteristics. It is indicators’ values with the country characteristics. It is expected that the results will provide a rough guidance to expected that the results will provide a rough guidance to country that already evaluated the NDP implementation in country that already evaluated the NDP implementation in strategy to improve the country achievement. strategy to improve the country achievement. Objective:Objective: To evaluate country characteristics, to confirm To evaluate country characteristics, to confirm the pattern of relationship between the NDP indicators’ the pattern of relationship between the NDP indicators’ values and the country characteristics, and to determine a values and the country characteristics, and to determine a rough guidance for identifying appropriate strategy.rough guidance for identifying appropriate strategy.Design & Method:Design & Method: descriptive-analytical, retrospective data descriptive-analytical, retrospective data collection. Results of evaluation of 13 NDPs were analyzed. collection. Results of evaluation of 13 NDPs were analyzed. Country data were arrayed in background, structure, Country data were arrayed in background, structure, process, and outcome categories. Data analyzed using process, and outcome categories. Data analyzed using content analysis, literature confirmation, cluster analysis, content analysis, literature confirmation, cluster analysis, and lambda correlation analysis.and lambda correlation analysis.Results:Results: Countries were classified into three characters Countries were classified into three characters representing their indicator values. The results showed that representing their indicator values. The results showed that information and continuing education on drug use capacity information and continuing education on drug use capacity was related (p<0.05) to the availabiliy of essential drug. was related (p<0.05) to the availabiliy of essential drug. Pricing policy implementation was influenced by Pricing policy implementation was influenced by drug drug sector status, public drug expenditure, total value of local sector status, public drug expenditure, total value of local production sold in the country and the number of production sold in the country and the number of pharmacist or pharmacist assistant. pharmacist or pharmacist assistant. Conclusions:Conclusions: Country background, pharmaceutical Country background, pharmaceutical capacity, NDP implementation and goal determine country capacity, NDP implementation and goal determine country character based on WHO indicators. Achievement of NDP character based on WHO indicators. Achievement of NDP goals were influenced by country character. The goals were influenced by country character. The relationship pattern could be used as a rough guidance to relationship pattern could be used as a rough guidance to identify the appropriate strategy to improve achievement. identify the appropriate strategy to improve achievement. Funding Source:Funding Source: Faculty of Medicine, Airlangga University, Faculty of Medicine, Airlangga University, Surabaya, IndonesiaSurabaya, Indonesia

ABSTRACTABSTRACT

INTRODUCTIONINTRODUCTION Many countries have used WHO indicators to Many countries have used WHO indicators to

evaluate the implementation of NDP, and evaluate the implementation of NDP, and data are available in WHO documents. data are available in WHO documents.

It would be interesting to evaluate the It would be interesting to evaluate the currently available country data, and to see if currently available country data, and to see if there is a particular pattern of relationship there is a particular pattern of relationship among indicators’ values with the country among indicators’ values with the country characteristics. characteristics.

It is expected that the results will provide a It is expected that the results will provide a rough guidance to country that already rough guidance to country that already evaluated the NDP implementation in evaluated the NDP implementation in strategy to improve the country achievement.strategy to improve the country achievement.

To evaluate country To evaluate country characteristics, characteristics,

To confirm the pattern of To confirm the pattern of relationship between the NDP relationship between the NDP indicators’ values and the country indicators’ values and the country characteristics, characteristics,

To determine a rough guidance for To determine a rough guidance for identifying appropriate strategy.identifying appropriate strategy.

OBJECTIVEOBJECTIVE

DESIGN & METHODSDESIGN & METHODSDescriptive-analytical with retrospective Descriptive-analytical with retrospective

data collection.data collection.Data presentation: Country data were Data presentation: Country data were

arrayed in background, structure, arrayed in background, structure, process and outcome categories of NDP process and outcome categories of NDP indicators. indicators.

Data analysis: Content analysis, Data analysis: Content analysis, literature confirmation, cluster analysis, literature confirmation, cluster analysis, and lambda correlation analysis.and lambda correlation analysis.

DATA COLLECTIONDATA COLLECTION

Chad

Bulgaria

Colombia Guinea

India(Andhra Pradesh)

IndonesiaMali

Philippines

Sri Lanka

Thailand

Viet NamZambia Zimbabwe

Published data. WHO Action Programme on Essential Drugs (1997), Comparative analysis of NDP in 12 countries,Geneva:WHO. WHO Collaboration Centre for Research and Training on Rational Drug Use (1998), Evaluation The Implementation of Indonesian NDP 1997, Yogyakarta:Gadjah Mada University.

RESULTS (1)RESULTS (1)

Key Component Key Component in The in The

GuidanceGuidance22

Key Component in Key Component in IndicatorsIndicators33

IndicatoIndicatorsrs

Selection of essential drugs

Selection of essential drugs

ST12-18, PR8-13

Affordability Affordability OT3-4

Drug financing Drug sector: economical data; drug allocation in the health budget

BG17-22; ST19-23, PR19-26

Supply systems Public sector procurement procedures, distribution and logistic, pricing policy

ST24-30, PR19-32

Regulation & quality assurance

Legislation & regulation ST1-11, PR1-7

Rational use information & continuing education on drug use

ST42-50, PR33-38

Human resources Human resources, information & continuing education on drug use

BG23-24; ST42-50, PR33-38

Appropriate indicators for key component of NDP according to WHO guidance1

1Result of content analysis; 2How to develop & implement NDP, WHO, 2001; 3Indicator for monitoring NDP, WHO, 1999.

RESULTS (2)RESULTS (2)

*based on political implementation through “legislation & regulation” and “drug allocation in the health budget”. **tentative classification caused by incomplete data.

Accomplishment Accomplishment of NDP objectiveof NDP objectiveHigher: Colombia,

Indonesia, Philippines, Zimbabwe; Bulgaria, Sri Lanka**

Middle: Guinea, Viet Nam

Lower: Chad, India (Andhra Pradesh); Mali, Thailand, Zambia*

Objective of NDPObjective of NDPAvailability of essential

drugs

Affordability of essential drugs

Quality of drugs

Rational use of drugs

Implementation of Implementation of NDP*NDP*

Higher: Bulgaria, Philippines, Sri Lanka, Thailand

Middle: Chad, Colombia, Viet Nam, Zimbabwe

Lower: Guinea, Mali, India (Andhra Pradesh), Indonesia

NDP key componentsNDP key componentsLegislation & regulation

Essential drug selection & drug registration

Drug allocation in the health budget

Public sector procurement procedures

Public sector distribution & logistics

Pricing policy

Information & continuing education on drug use

Support to NDPSupport to NDPHigher: Colombia,

Thailand, Indonesia

Middle: Bulgaria, Philippines, Sri Lanka, Zambia

Lower: Chad, Guinea, India (Andhra Pradesh), Mali, Viet Nam, Zimbabwe

Background of Background of NDPNDP

Country Info

Health Info

Drug Economic & Human Resource

Drug Sector Organization & Load

Country character based on indicator values

RESULTS (3)RESULTS (3)Relation-pattern of indicator categories

Background

Country Country InformationInformation

Average annual growth of population, GNP per capita, Average annual rate of inflation

ProcessImplementatioImplementatio

n of n of “Information & “Information &

Continuing Continuing Education on Education on

Drug Use”Drug Use”

Outcome

AvailabAvailability of ility of EssentiEssenti

al al DrugsDrugs

StructureCapacity of Capacity of

“Information & “Information & Continuing Continuing

Education on Education on Drug Use”Drug Use”

Outcome

AffordaAffordability of bility of EssentiEssenti

al al DrugsDrugs

BackgroundEconomic Data Economic Data

& Human & Human ResourceResource

Total public drug expenditure, total value of local production sold in the country, total number of pharmacy assistants & pharmacist

ProcessImplementImplement

ation of ation of “Pricing “Pricing Policy”Policy”Structure

Capacity of Capacity of “Pricing Policy”“Pricing Policy”

p<0.05, lambda correlation

DISCUSSION (1)DISCUSSION (1)

1Wold Bank classification; 2CIA World Factbook 2000 data.

Country character

Country income

classification1

Support to NDP

Countries

Implementation of “information &

continuing education on

drug use” strategy

Literacy rate2

Low Lower ZimbabZimbabwewe

Lower 85.0%

Low Lower ZambiaZambia Lower 78.2%

Low Lower IndiaIndia Lower 52.0%

Low Lower ChadChad Lower 48.1%

Low Lower GuineaGuinea Lower 35.9%

Low Lower MaliMali Lower 31.0%

confirmed confirmedCHARACTERIZATION

APPROPRIATE

RELATIONSHIP PATTERN

DISCUSSION (2)DISCUSSION (2)

ProcessImplementatioImplementatio

n of n of “Information & “Information &

Continuing Continuing Education on Education on

Drug Use”Drug Use”

ProcessImplementImplement

ation of ation of “Pricing “Pricing Policy”Policy”

BackgroundCountry Country

InformationInformation

Economic Data Economic Data & Human & Human ResourceResource

OutcomeAvailability Availability AffordabilityAffordability

Quality of Quality of drugsdrugs

Rational Use Rational Use of Drugsof Drugs

Relation of country characters based on indicator values

p<0.05, Lambda correlation p<0.05, Lambda correlation

p<0.05, Lambda correlation

Rough guidance:1. To improve specific outcome, prioritize related strategy implementation and supporting background.2. To evaluate of NDP implementation, compare with the achievement of other country that have similar

characters.

CONCLUSIONSCONCLUSIONS

Country background, Country background, pharmaceutical capacity, NDP pharmaceutical capacity, NDP implementation and goal determine implementation and goal determine country character.country character.

Accomplishment of NDP goals were Accomplishment of NDP goals were influenced by country character in influenced by country character in term of country background, term of country background, pharmaceutical system capacity pharmaceutical system capacity and implementation.and implementation.

RECOMMENDATIONSRECOMMENDATIONSGovernment is recommended to include Government is recommended to include

“information and continuing education on “information and continuing education on drug use” policy as a one of the priorities drug use” policy as a one of the priorities strategies to improve access on drugs.strategies to improve access on drugs.

For maximum implementation of “pricing For maximum implementation of “pricing policy”, government should meet policy”, government should meet economical status, human resources, and economical status, human resources, and capacity of pricing policy itself.capacity of pricing policy itself.

Need further study with more country Need further study with more country data to confirm more relationship pattern.data to confirm more relationship pattern.

CorrespondenceCorrespondence

Dripa Sjabana, dr., M.Kes.Dripa Sjabana, dr., M.Kes.Department of PharmacologyDepartment of PharmacologyFaculty of Medicine Airlangga UniversityFaculty of Medicine Airlangga University

Jalan Moestopo 47 Surabaya, Indonesia-60131Jalan Moestopo 47 Surabaya, Indonesia-60131

Email: Email: dripa@fk.unair.ac.iddripa@fk.unair.ac.id drip@farmako.comdrip@farmako.com